Breast Cancer Coordinated Care Conference in Washington DC

The BC3 conference is going on in washington DC currently and there is an interesting section on partial breast reconstruction. This field was first popularized in Europe, and is currently increasing in frequency at centers in the US... Essentially, the technique revolves around reconstruction of a lumpectomy defect by a plastic and reconstructive surgeon following the excision of a breast mass by rearrangement of the breast tissue in order to preserve the breast shape as much as possible...

happy new year

I recently read an article by the Independent (from the United Kingdom) relaying that at the Royal Marsden, 43 per cent of patients undergo reconstruction after a mastectomy - more than double the national UK average, according to last year's figures. It seems that although the number of patients who have had a mastectomy who have undergone reconstruction has increased in recent years, the number continues to be low; in this country, the number is likely no greater than 33%

New study from Daily News (Los Angeles 10/20)

A very recent report released this week stated that 43% of women diagnosed with breast cancer are not told about breast-reconstruction options from a survey by the nonprofit Cancer Support Community.

Also, nearly 88% of women who had discussed options with a surgeon were pleased with their subsequent decisions. These are the very numbers, that since the 1998 congressional act that allowed for breast reconstructive procedures to be covered under insurance that we are working towards improving....

Immediate vs. Delayed Reconstruction

There are many factors that go into the decision regarding the timing of breast reconstruction. Sometimes women prefer to proceed with a mastectomy and other needed cancer treatment, leaving the question of possible reconstruction for later. Sometimes there are clear medical reasons why a delay is preferable, and sometimes women strongly prefer a single major surgery and awakening with a "new" breast.

As breast reconstruction has become increasingly common, there have been more studies to determine the best and safest practice in a range of situations. Two recent studies have provided information about instances in which delayed reconstruction is safer and have been reassuring about chemotherapy, either pre or post surgery, not causing additional complications.

One study from Dr. Rodney Pommier and colleagues at the Oregon Health and Sciences University found that complications after radiation occurred in 44% of women who had immediate reconstruction and only 7% of women who did not (and who, presumably, had reconstruction later or not at all). Dr. Pommier suggests that sentinel node biopsies prior to mastectomy surgery will often identify those women who will likely need post-operative radiation therapy, and further discussion can then include the higher risk of complications from this course. At BIDMC, women who anticipate radiation therapy are often counseled to delay reconstruction until later.

The other study from UCSF found that women who had chemotherapy, either pre or post surgery, were no more likely to have surgical complications than women who did not receive chemotherapy. Thirty-one percent of women studied had a complication that required a second surgery, but the incidence was the same among women who had chemotherapy and those who did not.

If you would like to read more:

http://www.sciencedaily.com/releases/2010/09/100920172632.htm

All of this supports the need to have thoughtful discussions with your doctors as you consider your surgical options. No single course is best for all women, but we are increasingly able to individualize recommendations and understand the best choices for women making these difficult decisions.

2010 Making Strides Walk for Breast Cancer

This past sunday our nurse Maria walked and raised funds for Breast cancer research along with several breast reconstruction patients from our practice. Hopefully it wasn't too windy out during the day, but I hear that the walk was truly inspirational with many others whose lives have been affected by breast cancer also out for the afternoon - Congratulations to all!

Breast reconsruction at the American Society of Plastic Surgeons annual meeting

The annual meeting of the American Society of Plastic Surgeons is currently being held in Toronto, Canada, and a much discussed topic at the meeting the increasing role of using one's own fat as a "filling" agent from one part of the body to the chest/breast area in reconstruction; typically, this involves liposuction from one area to fill various areas of the breast reconstruction through a process of purifying the fat cells in the operating room. There is alot of basic science research going into understanding how these fat cells survive on their own in another part of the body

New study in Archives of Surgery about delayed reconstruction after mastectomy

There were 2 articles that came out about "delayed" reconstruction following mastectomy. While this adds another article to the discussion, it highlights the point about talking to your plastic and reconstructive surgeon about reconstruction and the nature of the disease.... for instance, for people who definitely need radiation after a mastectomy, delayed is an option to consider; tissue expanders, however, may still be placed at the time of mastectomy for two reasons - preserving the breast envelope skin, and providing at least one form of breast reconstruction during the process of radiation and treatment after mastectomy

there are considerations regarding how the final incisions/scars will appear with delayed reconstruction, and however in the long run, for instance, having a soft, durable abdominally based flap might be better.....regardless, ask your plastic surgeon about these options - understanding the process sometimes becomes involved!